Summary
Recent studies have suggested that both the subjective judgement of a physician and
standardized clinical models can be helpful in the estimation of the probability of
the disease in patients with suspected pulmonary embolism (PE). We performed a multi-center
study in consecutive in- and outpatients with suspected PE to compare the potential
diagnostic utility of these methods. Of the 517 study patients, 160 (31%) were classified
as having PE. Of these patients, 14% had a low probability as estimated by the treating
physician, while 25 to 36% were categorized as having a low clinical probability with
the use of two previously described clinical models. The objectively confirmed prevalence
of PE in these three low probability categories was 19%, 28% and 28%, respectively.
The three methods yielded comparable predictive values for PE in the other probability
categories. We conclude that a physician’s clinical judgement alone and two standardized
clinical models, although comparable, perform disappointingly in categorizing the
pre-test probability in patients with suspected PE.
Keywords
Pulmonary embolism - diagnosis - probability - estimate - model
